Communicable diseases infectious types. 6-9 months of National Tuberculosis Control treatment. Program – key policies ▪ Multibacillary/MB – infectious Case finding – direct Sputum types. 24-30 months of Microscopy and X-ray treatment. examination of TB symptomatics Multi-drug therapy – use of 2 or more drugs who are negative after 2 or more renders patients non-infectious a week after sputum exams starting treatment Treatment – shall be given free ▪ Patients w/ single skin lesion and and on an ambulatory ambulatory basis, a negative slit skin smear are except those with acute treated w/ a single dose of ROM complications and emergencies regimen Direct Observed Treatment Short ▪ For PB leprosy cases- Course – comprehensive strategy Rifampicin+Dapsone on Day 1 to detect and cure TB patients. then Dapsone from Day 2-28. 6 Category and Treatment Regimen blister packs taken monthly Category 1- new TB patients whose sputum is within a max. period of 9 mos. positive; seriously ill patients with severe forms All patients who have complied w/ MDT are of smear-negative PTB with extensive considered cured and no longer regarded as a parenchymal involvement (moderately- or far- case of leprosy, even if some sequelae of leprosy advanced) and extra-pulmonary TB (meningitis, remain. pleurisy, etc.) Responsibilities of the nurse Category 2-previously-treated patients with ▪ Prevention – health education, relapses or failures. healthful living through proper Category 3 – new TB patients whose sputum is nutrition, adequate rest, sleep smear-negative for 3 times and chest x -ray and good personal hygiene; result of PTB minimal ▪ Casefinding Category 1- ▪ Management and treatment – prevention of secondary injuries, new TB patients whose sputum is positive; handling of utensils; special seriously ill patients with severe forms of smear- shoes w/ padded soles; negative PTB with extensive parenchymal importance of sustained therapy, involvement (moderately- or far- advanced) and correct dosage, effects of drugs extra-pulmonary TB (meningitis, pleurisy, etc.) and the need for medical check- Intensive Phase (given daily for the first 2 months)- up from time to time; mental & Rifampicin + Isioniazid + pyrazinamide + ethambutol. emotional support If sputum result becomes negative after 2 months, ▪ Rehabilitation-makes patients maintenance phase starts. But if sputum is still positive capable, active and self- in 2 months, all drugs are discontinued from 2-3 days respecting member of society. and a sputum specimen is examined for culture and drug Control of Schistosomiasis – a tropical disease caused by sensitivity. The patient resumes taking the 4 drugs for a blood fluke, Schistosoma Japonicum Schistosoma Japonicum ; transmitted by a another month and then another smear exam is done at tiny snail Oncomelania quadrasi the end of the 3rd month. Preventive measures – health education Maintenance Phase (after 3rd month, regardless of the regarding mode of transmission and methods of result of the s putum exam)-INH + rifampicin daily protection; proper disposal of feces and urine; Category 2-previously-treated patients with relapses or improvement of irrigation and agriculture failures. practices Intensive Phase (daily for 3 months, month 1,2 & 3)- Control of patient, contacts and the immediate Isioniazid+ rifampicin+ pyrazinamide+ ethambutol+ environment streptomycin for the first 2 months Streptomycin+ Specific treatment- Praziquantel – drug of choice rifampicin pyrazinamide+ ethambutol on the 3rd month. Programs on Filariasis, Malaria and Dengue Hemorrhagic If sputum is still positive after 3 months, the intensive Fever phase is continued for 1 more month and then another sputum exam is done. If still positive after 4 months, Filariasis- a chronic prasitic infection caused by intensive phase is continued for the next 5 months. a nematode, Wuchereria bancrofti. Young bancrofti. Young and Maintenance Phase (daily for 5 months, month 4,5,6,7,& adult worms live in the lymphatic vessels and 8)-Isionazid+ rifampicin+ ethambutol nodes, while the micro filariae are in the blood; Category 3 – new TB patients whose sputum is smear- transmitted through bites from an infected negative for 3 times and chest x-ray result of PTB female mosquito, Aedes poecilius, Aedes poecilius, that bites at minimal night. Intensive Phase (daily for 2 months) – Isioniazid ▪ Treatment: Diethylcarbamazine + rifampicin + pyrazinamide citrate or Hetrazan Maintenance Phase (daily for the next 2 months) ▪ Elephantiasis and Hydrocoele - Isioniazid + rifampicin are handled through surgery, Stop TB ; Do it with DOTS prevention and supportive care Malaria – infection caused by the bite of the female Advocacy is a planned and continuo us effort to Anopheles mosquito, mosquito, inform people about issue and instigate change. Chemoprophylaxis – Chloroquine taken Advocacy usually takes place over an extended at weekly intervals, starting from 1-2 period of time and includes a variety of weeks before entering the endemic area. strategies to communicate a specific message. Anti-malarial drugs – sulfadoxine, TB is the number one infectious killer in the quiinine sulfate, tetracycline, quinidine world. Insecticide treatment of mosquito nets, One TB suspect can infect another 10 healthy house spraying, stream seeding and persons clearing, sustainable preventive and Leprosy Control Program vector control meas WHO Classification – basis of multi-drug therapy Dengue H-fever 4 o’clock habit type of assessment responds to a Programs on Measles. Chickenpox, particular need Mumps, Diphtheria, Pertusis, Tetanus – ELEMENTS OF focused on health information COMPREHENSIVE COMPREHENSIVE COMMUNITY DIAGNOSIS campaigns and intensive immunization 1. DEMO DEMOGR GRAPAPHIHIC C VARI VARIABABLELESS of children in barangays. i. Tota Totall popu popula lati tion on & Geog Geograraph phic ical al Prevention and Control Program on Parasitic distribution including Urban-Rural index Infestations ( STH e.g. Ascaris, Trichuris, Hookworm) and & Population Density Paragonimiasis in communities where eating of fresh or ii. Age & Sex composit iio on inadequately cooked crab is a practice iii. iii. Sele Selectcted ed vit vital al ind indic icat ator orss e.q. e.q. Gro Growt wth h Management: rate, CBR, CDR & Life expectancy rate 1. Deworming iv. Patterns of migrat iio on 2. Health Education re: v. Population project iio on ▪ Good personal hygiene Note: ▪ Use of footwear Population groups that need special ▪ Washing fruits and vegetables attentions: well ▪ Indigenous people ▪ Use of sanitary toilets ▪ Socially dislocated groups as a ▪ Sanitary disposal of garbage result of disasters, calamities & ▪ Boiling drinking water at least 2- development programs 3 min. from boiling point or 2. Socio- Socio-eco econom nomic ic & Cultu Cultural ral vari variabl ables es chlorination i. Social inindicators Prevention and Control on Leptospirosis/ Leptospirosis/ Weil’s Disease/ Communication network Mud fever/Flood fever/ Spirochetal Jaundice thru contact with Transportation system the skin/ open wound with water or moist soil contaminated Educational level with urine of infected rat Housing conditions And Rabies ii. Economic indicators Mgt. of Rabies Poverty level income Wash wound with soap and water, betadine or Employment rate alcohol may be applied Types of industry present in the If dog is healthy observe for 14 days. days. If nothing community happens- no need for ttt.If it dies or shows rabies, kill then bring head for lab. Exam & Occupation common in the community iii. iii. Env Enviro ironme nmentalntal ind indicat icatoors consult doctor. Active immunization – body develops Ab against Physical/geographical/topographical characteristics rabies up to 3 yrs. Water supply Passive I – giving Ab to persons with head and neck bites, multiple single deep bites, Waste disposal contamination of mucous membranes or thin Air, Water and Land pollution covering of the eyes, lips or mouth to provide iv. Cultural fa factors immediate protection Variables that may break up people into RPO – immunization of pets at 3 mos. of age and groups within the community e.q. yearly thereafter ▪ Ethnicity Prevention and Control on STIs ▪ Social class - Gonorrhea, Syphilis, HIV/AIDS, ▪ Language Trichomoniasis,Chlamydia, Trichomoniasis,Chlamyd ia, Hep B ( the most most ▪ Religion serious type ‘cause of severe cx. Eg. Massive ▪ Race liver damage and hepatocarcinoma ▪ Political orientation - 4 C’s in the Syndromic Syndromic Mgt Cultural beliefs and practices that affect - 1. Compliance health - 2. Counseling/ Education Concepts about Health and Illness - 3. Contact tracing to treat partner 3. Heal Healthth & illn illnes esss patt patter erns ns - 4. Condom use Leading cause of mortality - Hep B vaccination Leading cause of morbidity - Universal precautions Leading cause of infant mortality - Safe sex Leading cause of maternal mortality 2. Community Needs Assessment/ Community Diagnosis Leading cause of hospital admission Community Diagnosis 4. Heal Healthth reso resoururce ces s A process by which the nurse collects data about Manpower resources the community in order to identify factors which Material resources may influence the deaths and illnesses of the 5. Politi Political cal/Le /Leade adershi rshipp patte patterns rns population Reflects the action potential of the state to formulate a community health nursing and its people to address the health diagnosis and develop and implement community needs and problems of the community health nursing interventions and strategies Mirrors the sensitivity of the Done to come up with a profile of local health government to the people’s struggle for situation better lives Will serve as a basis of health programs and PROCESS OF COMMUNITY DIAGNOSIS services to be delivered to the community Consists of; Starts with determining the health status of the 1. Collec Collectin ting, g, organi organizin zingg & synthesi synthesizin zing g data data community In order to identify the different factors 2 Types of Community Diagnosis that may directly or indirectly influence 1. Compre Comprehenhensiv sivee Commun Community ity Diag Diagnos nosis is the health of the population aims to obtain general information about 2. Analyz Analyzinging & inter interpre preting ting health health data data the community Seek explanations for the occurrence of 2. Proble Problem-O m-Orie riente nted d Communi Community ty Diagno Diagnosis sis health needs and problems of the community 3. Formul Formulati ation on of Comm Communi unity ty Healt Health h Nursing Nursing Perception of the population or the Diagnoses community as they are affected by the Will become the bases for developing problem and their readiness to act on and implementing community health the problem nursing interventions and strategies PLANNING STEPS IN CONDUCTING COMMUNITY WHAT IS PLANNING? DIAGNOSIS is a process that entails formulation of 1. DETERMINING THE OBJECTIVES – the nurse steps to be undertaken in the future in decides on the depth and scope of the of the data she order to achieve a desired end. needs to gather. Concepts of Planning: 2. DEFINING THE STUDY POPULATION – the nurse Planning is futuristic. identifies the population group to be included in the study. Planning is change-oriented. 3. DETERMINING THE DATA TO BE COLLECTED – the Planning is a continuous and dynamic objectives will guide the nurse in identifying the process. specific data she will collect, and will also decide Planning is flexible. on the sources of these data. Planning is a systematic process. 4. COLLECTING COLLECTING THE DATA – the nurse decides on THE PLANNING CYCLE: the specific methods depending on the type of data to be generated. 1. Situational Analysis Ocular survey, survey, interview, and records records gather health data review, tabulate, analyze and interpret data 5. DEVELOPING THE INSTRUMENT instruments/tools facilitate the nurse’s data-gathering activities. identify health problems Most common instrume in struments nts : set priority survey questionnaire 2. Goal and Objective Setting interview guide define program goals and objectives observation checklist assign priorities among objectives 6. ACTUAL DATA GATHERING – the nurse supervises 3. Stra Strate tegy gy/A /Act ctiv ivit ity y Sett Settin ing g the data collectors by checking the filled-up Design CHN Program instruments in terms of completeness, accuracy Ascertain resources and reliability of the information collected. Analyze constraints and limitations 7. DATA COLLATION – the nurse is now ready to put 4. Evaluation together all the information. determines outcomes Numerical data specify criteria and standards Descriptive data Application of Public Health Tools (discuss ( discuss in separate slide) 8. DATA PRESENTATION – will depend largely on Three important tools the type of data obtained. The health disciplines of Descriptive- narrative reports 1. Demography numerical data- table or graphs 2. Vital statistics 9. DATA ANALYSIS – aims to establish trends and patterns in terms of health needs and problems 3. Epidemiology 3. COMMUNITY ORGANIZING of the community. 10. Identifying Community Health Nursing Problems A process whereby the community members a. Heal Health th Stat Statusus Prob Proble lemsms develop the capability to assess their health Increased/decreased morbidity, needs and problems, plan and implement actions to solve these problems, put up sustain mortality fertility or reduced capability for wellness organizational structures which will support and monitor implementation of health initiatives by b. Heal Health th Reso Resour urce ces s Probl Problememss the people Lack of or absence of manpower, money, materials or institutions necessary to maglaya solve health problems COMMUNITY ORGANIZING c. Heal Health th Rela Relate ted d Pro Probl blememss Purpose: Existence of social, economic, Empowerment or building the capability environmental and political factors that of people for future community action aggravate the illness-inducing situations Approaches to community development in the community a. Soci Social al chan changges 11. Priority-se Priority-setting tting Building up social organizations a. Nature Nature of the the conditi condition/on/pro proble blem m present presented ed (relationships, structure and resources) Classified as health status, health b. Chan Changege in ide ideol olog ogyy resources or health related problems Knowledge, beliefs and attitude b. Magn Magnit itud ude e of the the pro problblem em c. Chan Chang ge agen agentsts Severity of the problem which can be Capacity to influence others by setting a measured in terms of the proportion of good example. the population affected by the problem Principles of CO: c. Modi Modififiab abililit ity y of the the prob problelem m 1. Welf Welfar aree app appro roac achh Probability of reducing, controlling or People esp. the oppressed, exploited and eradicating the problem deprived sectors are most open to change, have d. Prev Preven entitive ve pote potentntia iall the capacity to change and are able to bring Probability of controlling or reducing the about change. Hence , CO is based on the ff: effects posed by the problem a. Power Power must must resi reside de in the the peop people le e. Soci Sociaal con concecernrn b. Develo Developmpment. ent. is from from the the peopl people e to the the b. Coalition- Coaliti on- linking organizations organiza tions and people groups to work on community issues. c. Peop People le part partic icip ipat atio ion n 2. Tech Techno nolo logi gica call appr approa oachch c. “lead” or official agency- a single agency must be based on the poorest sectors of society. takes the primary responsibility of a The solutions of problems commonly shared by liaison for health promotion activities in these sectors must be focused on collective the community. organizations, planning and action d. Grass-roots- informal structures in the 3. Tran Transf sfor orma matotory ry app appro roahah community like the neighbourhood should lead to self-reliant communities residents. Five stages e. Citizens panels- a group of citizens (5- 1. Community analysis 10) emerge to form a partnership with 2. Design and initiation the government agency.
3. Implementation f. Networks and consortia- network
develop because of a certain concerns 4. Program maintenance – consolidation 3. Identi Identify, fy, selec selectt and recruit recruit orga organiz nizati ationa onall 5. Dissemination – reassessment members. 1.Community analysis As much as possible different groups, The process of assessing and defining needs, organizations sectors should be opportunities and resources involved in represented. initiating community health action . Chosen representative have power for Maybe referred to as community diagnosis, the group they represents community needs assessment, health education 4. Define Define the organi organizat zation ion missio missionn and and goals goals.. planning and mapping This will specify the what, who, where, 5 components of community analysis when and extent of the organizational 1. Demograp Demographic, hic, social and economic economic profile profile of the objectives. community derived from secondary data. 5. Clarif Clarify y roles roles and respo responsib nsibili ilitie ties s of people people 2. Health Health risk risk profi profilele (socia (social,l, behav behaviou ioural ral and and involved in the organization. environmental risks) This is done to establish a smooth Behavioural- dietary habits and other life working relationship and avoid style concerns like alcohol, tobacco and overlapping of responsibilities. drugs 6. Provid Provide e train training ing and recog recogniti nition. on. Social indicators- exposure to long term Active involvement in planning and unemployment, low education and management of programs may require isolation. skills development training. 3. Health Health/we /wellne llness ss out out come comes s profi profile le Recognition of the programs (morbidity/mortality data) accomplishment and individuals 4. Survey Survey of curre current nt health health promot promotion ion progr programs ams.. contribution to the success of the 5. Studie Studies s conduct conducted ed in certa certain in targe targett groups groups program and boost morale of the Steps in community analysis members. Steps in community analysis 3.Implementation i. Defining the community -put the design plan into action. 1. Dete Determrmin inin ingg the the geog geogra raph phicic bou boundndar arie iess a. Genera Generate te broad broad citi citizen zen part partici icipat pation ion of the target community How? ii. Collecting data ▪ Organizing task force, who, with iii. iii. Asse Assessssin ingg comm commun unitityy capa capaci city ty appropriate guidance can 1. Enta Entailils s an an eva evaluluat atio ionn of of the the driv drivin ing g provide the necessary support. forces which may facilitate or impede b. Develo Developp a sequen sequentia tiall work work plan plan the advocated change Activities should be planned iv. iv. Asses ssessi sing ng com comm munit unity y bar barrier riers s sequentially. Often, times has to be v. Asses ssessi sing ng read eadines iness s to to cha changnge e modified as events unfold. Community 1. Community interest members may have to constantly 2. Perc Percepeptition on on the the imp impororta tancncee of of the the monitor implementation steps. problem c. Use compre comprehen hensiv sive, e, integr integrate ated d strateg strategies ies vi. vi. Synt Synthehesi sis s dat dataa and and setset pri prior orititie ies s Generally the program utilize more than 1. Prov Provididee a com commu muninity ty pro profifile le of of the the nee needs ds one strategies that must complement and resources and will become the Basis each other. for designing prospective community d. Integrate Integrate community community values values into into the the programs, programs, interventions for health promotion materials and messages. 2.Design and initiation STEPS: The community language, values and norms have to be incorporated into the 1. Establish a core planning group and select a program. local organizer. 4.Program maintenance – consolidation Requirements: The program a this point has experienced s ome Select 5-8 member in charge for core degree of success and has weathered through planning and management of the implementation problems, the organization and program program is gaining acceptance in the With management skills, good listener community. and conflict resolution skills. Maintenance: 2. Choose Choose an org organi anizat zation ional al struc structur ture. e. a. Integr Integrate ate interve interventi ntion on activiti activities es into commun community ity This activate the community networks participation. This can be affected through Types: implementation problems. a. Leadership Leadersh ip board council- council - existing local The organization and program is gaining leaders working for a common cause acceptance in the community. b. Establish Establish a positive positive organizat organizational ional culture. culture. A positive environment is a critical Short-term service element in maintaining cooperation and HISTORY OF HRDP preventing fast turnover of members. HRDP II This is a result of good group process The 2nd cycle uses the same strategy but based on trust, respect, and openness. the program could not be sustained by c. Establ Establish ish an an ongoi ongoing ng recr recruit uitmen mentt plan. plan. the schools or hospitals and the income- It should be expected that volunteers generating projects eventually become may leave the organization. the hindrance to the goal of achieving This requires a built in mechanisms for the health program because the people continuous recruitment and training of tend to be more interested in the income new members. generated by the projects d. Disse Dissemi mina nate te resul results ts.. Both HRDP I and HRDP II have brought Continuous feedback to the community about some changes in the community on results of activities enhances life of the people visibility and acceptance of the Established basic health infrastructure; organization. basic health services were increased; Dissemination of information is vital to there were trained workers and gain and maintain community support. organized health groups to take care of 5.Dissemination-Reassessment 5.Dissemination-Reassessment the needs of the community Continuous assessment is part of the monitoring HISTORY OF HRDP aspect in the management of the program HRDP III a. Update Update the commun community ity analys analysis. is. PCPD refined the program and resulted Is there a change in leadership, to what is now called HRDP III, which has resources and participation? these unique features: This may necessitate reorganization and ▪ Comprehensive training of the new collaboration with other staff and faculty of the organizations. participating agency in which the b. Assess effectiven effectiveness ess of interventio interventions/pr ns/program ograms. s. community work was initiated Quantitative and qualitative methods of ▪ Periodic training program and evaluation can be used to determine regular assistance to the participation, support and behavior participating agency were change level of decision making and provided to strengthen the other factors deemed important to the health outreach program to program. become community oriented c. Chart Chart futur futuree direct directori ories es and mod modific ificati ations ons.. ▪ PHC as the approach with which This may mean revision of goals and all nursing/medical students, objectives and development of new their CI’s and indigenous health strategies. workers are trained for Revitalization of collaboration and community health work and networking may be vital in support of around which all other project new ventures. inputs will revolve d. Summar Summarizeize and and diss dissemi eminat nate e result results. s. HISTORY OF HRDP Some organization die because of the Community organizing as the main lack of visibility. strategy to be employed in preparing the communities to develop their community Thus, a dissemination plan may be health care systems and the helpful in diffusion of information to establishment of community health further boost support to the organization to manage the community organization’s endeavour. health programs The Health Resource Development Program Organizing work in the communities Community Health Organizing Utilizing COPAR were done in 3 phases HRDP PAR as fascinating strategy for Was developed and sponsored by the Philippine maximum community involvement Center for Population and Development (PCPD) through collective identification and To make health services available and accessible analysis of community health problems to depressed and underserved communities in and collective health action the Philippines Available funds to finance community PCPD is a non-stock, non-profit institution, which initiated projects serves as a resource center assisting institutions COPAR? and agencies through programs and projects Since Management Leadership and geared toward the social human development of Jurisprudence are courses taught in the rural and urban communities classroom members of this group of students Formerly known as The Population Center were trained to manage and acts as leaders of Foundation the different levels of the students who were HISTORY OF HRDP involved in COPAR HRDP I Principles of management were applied in Trained the faculty, medical/nursing carrying out primary health care students to provide health care services The community members, members, CHW’s CHW’s and leaders to the far flung barrios because of lack were empowered to manage their own health of man power for health services at the projects same time that similar activities fulfilled Conducted seminars and trainings as well as the curricular requirements of the health education and services needed by students for public health community(exposure and immersion 6-8 weeks) The PCPD provides seed money money for the THE HRDP-COPAR PROCESS income generating projects 1. PRE- PRE-ENENT TRY PHAS PHASE E The CO uses his/her own strategy or 2. ENTRY PH PHASE method in developing the community 3. COMMU COMMUNI NITY TY STUDY/ STUDY/DIA DIAGNO GNOSIS SIS § avoid gambling and drinking PHASE/RESEARCH PHASE Deepening social investigation/community study 4. COMMUNIT COMMUNITY Y ORGANIZAT ORGANIZATION ION AND CAPABILIT CAPABILITY- Y- verification and enrichment of data collected BUILDING PHASE from initial survey 5. COMM COMMUNUNITITY Y ACTI ACTION ON PHA PHASE SE 6. SUSTEN SUSTENANANCECE AND STRE STRENG NGTHE THENIN NING G PHASE PHASE conduct baseline survey by students, 1. Pre-Entry Phase results relayed through community assembly Preparation of the Institution Train faculty and students in COPAR. Leader Spotting Through Sociogram. Formulate plans for institutionalizing COPAR. Key persons - approached by most people Revise/enrich curriculum and immersion Opinion leader - approach by key persons program. Isolates - never or hardly consulted Coordinate participants of other departments. 4.NCD prevention and control program 1. Preven Preventio tionn and Contr Control ol of Cardi Cardiova ovascul scular ar Site Selection Diseases Initial networking with local government. 2. Cancer Cancer Prev Prevent ention ion and and Earl Early y Detec Detectio tion n Conduct preliminary special investigation. 3. Nat’l Nat’l Diabete Diabetes s Prevent Prevention ion and Control Control Progra Program m Make long/short list of potential communities. 4. Preven Preventio tionn and Cont Control rol of of Kidney Kidney Dise Disease ase Do ocular survey of listed communities. 5. Progra Programm on Mental Mental Healt Healthh and Mental Mental Disor Disorder ders s Criteria for Initial Site Selection 6. Prog Progra ram m on Drug Drug Depe Dependnden ence/ ce/ Substance Abuse o Must have a population of 100-200 families. 7. Commun Communityity-Ba -Based sed Rehabi Rehabilit litati ation on Program Program o Economically depressed. 8. Progra Programm on the Elder Elderly/ ly/Ger Geriat iatric ric Nursi Nursing ng o No strong resistance from the community. Services o No serious peace and order problem. 9. Progra Programs ms onon Blindn Blindness ess,, Deafn Deafness ess and and o No similar group or organization holding the Osteoporosis same program. 1. Prevention and Control of Cardiovascular Diseases Identifying Potential Barangay heart – 1st leading cause of death
o Do the same process as in selecting
blood vessels - 2nd municipality. Types: o Consult key informants and residents. 1. Cong Congen enit ital al Hea Heart rt Dis Disea ease se (CH (CHD) D):: o Coordinate with local government and NGOs 2. Rheu Rheumat matic ic Fev Fever er or Rhe Rheuma umatic tic Heart Heart Dise Disease ase for future activities. 3. Hyp Hyperte ertens nsio ionn Choosing Final Barangay 4. prim primar ary y or esse essentntia iall o Conduct informal interviews with community 5. Ischem Ischemicic Heart Heart Diseas Disease/e/ Athero Atheroscl sclero erosis sis residents and key informants. 1.Congenital Heart Disease (CHD): Result of the o Determine the need of the program in the abnormal development of the heart that exhibits community. septal defect, patent ductus arteriosus, aortic and o Take note of political development. pulmonary stenosis, and cyanosis; most prevalent in o Develop community profiles for secondary children data. Causes: environmental factors, maternal diseases or genetic aberrations o Develop survey tools. 2. Rheuma Rheumatictic Fever Fever or Rheu Rheumat matic ic Heart Heart Diseas Disease: e: o Pay courtesy call to community leaders. Systematic inflammatory disease that may o Choose foster families based on guidelines. develop as a delayed reaction to repeated and Identifying Host Family an inadequately treated infection of the upper o House is strategically located in the respiratory tract by group A beta-hemolytic community. streptococci. o Should not belong to the rich segment. 3. Hypert Hypertens ension ion:: Persist Persistent ent eleva elevatio tion n of the o Respected by both formal and informal arterial blood pressure. leaders. 4. primary primary or essential) essential) ;frequent ;frequent among among females females but severe,malignant form is more common o Neighbours are not hesitant to enter the among males house. 5. Ischem Ischemicic Heart Heart Diseas Disease/e/ Athero Atheroscl sclero erosis: sis: o No member of the host family s hould be Condition usually caused by the occlusion of the moving out in the community. coronary arteries by thrombus or clot formation. 2. Entry Phase higher among males than females for the latter Guidelines for Entry are protected by estrogen before menopause o Recognize the role of local authorities by PF: HPN, DM, Smoking paying them visits to inform their presence and Minor RF: stress, strong family history, obesity activities. CVD o Her appearance, speech, behavior and lifestyle CVD should be in keeping with those of the Primary Prevention: CVD community residents without disregard of their Primary Prevention thru health education is the being role model. main focus of the program: o Avoid raising the consciousness of the 1. mainte maintenan nancece of ideal ideal body body wt. community residents; adopt a low-key profile. 2. diet - low fat Activities in the Entry Phase 3. alcoho alcohol/s l/smok moking ing avoida avoidance nce Integration - establishing rapport with the 4. Exercise people in continuing effort to imbibe community 5. regu regula lar r BP BP che checkck up life. 2. Cancer Cancer Prev Prevent ention ion and and Early Early Detect Detection ion Any malignant tumor arising from the abnormal § living with the community and uncontrolled division of cells causing the § seek out to converse with people destruction in the surrounding tissues. where they usually congregate § lend a hand in household chores Common Cancer: Lung cancer, cervical cancer, Goal: To improve the quality of life and increase colon cancer, cancer of the mouth, breast productivity of disabled, handicapped persons. cancer, skin cancer, prostate cancer. Aim: To reduce the prevalence of disability 3rd leading cause of illness and death ( Phil.) through prevention, early detection and provision of rehabilitation services at the Incidence can only be reduced thru prevention thru prevention community level. and early detection 8. Progra Program m on the Elder Elderly/ ly/Ger Geriat iatric ric Nursi Nursing ng NINE WARNING SIGNS OF CANCER: Services Change in blood bowel or bladder habits 7 humanitarian issues: family, health, income, A sore that does not heal security, employment employment and labor, labor, social welfare, Unusual bleeding or discharge education, recreation, culltural activities and Thickening or lump in breast or elsewhere housing Indigestion or difficulty in swallowing Leading causes of illness:elderly Obvious change in wart or mole Influenza, HPN, diarrhea, Nagging cough or hoarseness bronchitis, TB, diseases. of the heart, Unexplained anemia pneumonia, malaria, Sudden unexplained weight loss malignant neoplasm, chickenpox Prevention & Early Detection Leading causes of death:elderly PRINCIPLES OF TREATMENT OF MALIGNANT DISEASES Diseases of heart and vascular system One third of all cancers are curable if Pneumonia, TB, CCOPD detected early and treated properly. Malignant neoplasms Three major forms of treatment of cancer: Diabetes Surgery Nephritis Radiation Therapy Accidents Chemotherapy 9.Programs on Blindness, Deafness and Osteoporosis 3.Nat’l Diabetes Prevention and Control Program Cataract- main causes of blindness Aim: VAD- main cause of childhood blindness; most Controlling and assimilating healthy lifestyle in serious eye problem of Fil. children below 6 yrs. the Filipino culture ( 2005-2010) thru IEC old Main Concern: modifiable risk factors( diet, body Osteoporosis special problem in women, wt., smoking, alcohol, stress, sedentary living, highest bet. 50—79 yrs. old, MENOPAUSE- main birth wt. ,migration cause 4.Prevention and Control of Kidney Disease Prevention of NCD/Role of Nursing in Health Promotion Acute or Rapidly Progressive Renal Failure : A And Advocacy sudden decline in renal function resulting from the Yosi Kadiri- anti smoking failure of the renal circulation or by glomerular or Edi Exercise/Hataw-regular physical activity tubular damage causing the accumulation of Tiya Kulit/ Iwas Sakit Diet-low salt, low fat, high substances that is normally eliminated in the urine in fiber diet the body fluids leading to disruption in homeostatic, Mag HL – exercise, no smoking, avoidance of endocrine, and metabolic functions. alcohol, healthy diet, iwas stress, watch wt. Acute Nephritis: A severe inflammation of the kidney Sentrong Sigla Movement ( SSM) caused by infection, degenerative disease, or disease -a certification recognition program which develops and of the blood vessels. promotes standards for health facilities - Joint effort bet.: Chronic Renal Failure: A progressive deterioration of 1.DOH – provides technical and financial assistance renal function that ends as uremia and its packages for health care complications unless dialysis or kidney transplant is 2. LGUs – direct implementers of health programs & performed. prime developers developers of health centers and hospitals Neprolithiasis: A disorder characterized by the making services accessible to every Filipino presence of calculi in the kidney. Pillars of SSM Nephrotic Syndrome: A clinical disorder of 1. Qual Qualit ity y Ass Assur uran ance ce excessive leakage of plasma proteins into the 2. Grant Grant and Techni Technical cal Assist Assistanc ance e urine because of increased permeability of the 3. Heal Health th Prom Promot otio ionn glomerular capillary membrane 4. Awards Urinary Tract Infection: A disease caused by the Expected Outcome: SSM presence of pathogenic microorganisms in the Empowered individuals adopting healthy urinary tract with or without signs and lifestyle, improved improved health-seeking behavior and symptoms. well-being & increased demand for quality Renal Tubular Defects: An abnormal condition in health services the reabsorption of selected materials back into Institutions will develop policies, provide quality the blood and secretion, collection, and services , institute system for surveillance/ conduction of urine. merits and advocate for laws Urinary Tract Obstruction: A condition wherein Programs: SSM the urine flow is blocked or clogged. EPI 5. Program on Mental Health and Mental Disorders Disease Surveillance 6. Program on Drug Dependence/ CARI Substance Abuse CDD 7.Community-Based Rehabilitation Program Nutrition/ Micronutrient Supplementation- A creative application of the primary health care *Food Fortification : approach in rehabilitation services, which Rice –iron; Oil and sugar – Vit. A; involves measures taken at the community level Flour-Vit. A & iron; Salt- iodine to use and build on the resources of the community with the community people, Integrated Management of Childhood Illness including impaired, disabled and handicapped ( IMCI) persons as well. Integrates management of most common 5. Surv Survei eill lla ance nce childhood problems problems ( diarrhea, pneumonia, 6. Reco Record rdin ingg and and rep repor orti ting ng measles, malnutrition, DHF, malaria) 7. epid epidem emio iolo log gy Involves family members and community in the IV. SPECIAL FIELDS IN COMMUNITY HEALTH NURSING health care process for physical growth and School nursing mental development & disease prevention and IV. The Public Health Nurse occupational health nursing Definition and terms: School nursing Public Health Nursing A type of public health nursing that focuses on refers to the practice of nursing in local/national the promotion of health and wellness of the health departments (which includes health pupils/students, teaching and non teaching centers and rural health units) and schools. personnel of the schools. It is a community health nursing practice in the The primary role is to support the student public sector learning and ensure that educational potential is Public Health Nurses not hampered by unmet health needs Refers to the nurses in the local/national health Assist the students in making choices for a departments or public schools whether their healthy life style, reduce risk taking behaviour official position title is public health nurse or and focus on issues such as prevention of drug nurse or school nurse and substance abuse, teenage pregnancy, Leaders in providing quality health services to the STD,Malnutrition, CD and NCD communities First level of health workers to be founded by: Lillian Wald (1902) knowledgeable about new public health a member of the professional educational technologies and methodologies employed to aid students in developing their full Usually the first ones to be trained to implement health potential in health and education new programs and apply new technologies HNC (health and Nutrition Center) of the DepEd Qualifications Mandated to safeguard the health and Must be professionally qualified and licensed to nutritional well-being of the total school practice in the arena of public health nursing population. Consistent with the nursing law of 2002 (RA 2 division 9173) 1. health 7 Roles and Functions 1. Mana Manage geme ment nt func functi tion on 4 sections Inherent in the practice of PHN Medical Organizes the nursing service of the Dental local health agency Nursing Applications of 5 management Functions Health education “POSDC” in organizing the nursing 2. nutr nutrit itio ion n divi divisi sion on service and the local health agency. Objectives of School Nursing 2. Supe Superv rviso isoryry func functi tion on General: General: To promote promote and maintain maintain the health of Supervisor of the midwives and other the school populace by proving comprehensive health workers and quality nursing care. 3. Nurs Nursiningg car caree func functi tion on 6 Specif Spe cific ic : Inherent function of the nurse 1. Provid Provide e quality quality nursi nursing ng servic service e to the school school Based on the science of art and caring population Caring for all levels of clientele toward 2. Create Create awaren awareness ess among among child children ren,, personn personnelel health promotion and disease prevention and administrators on the importance of the 4. Collab Collabora oratin tingg and coordi coordinat nating ing functi function on promotive and preventive aspects of health Care coordinators for communities and through health education. their members 3. Encour Encourageage thethe provisi provisionon of standar standard d functio functional nal Establishes linkages and collaborative facilities relationships with other health 4. Providing Providing nursing nursing personnel personnel with opportuniti opportunities es professionals, government agencies, for continuing education and training. private sectors, NGO’s people’s 5. Conduc Conductt and partic participa ipate te in researc researcheshes relate relatedd to organizations to address health nursing care. problems 6. Establish/ Establish/ strengthen strengthen linkages linkages with governmen governmentt 5. Health Health prom promotiotion on and educ educati ation on functi function on and non-government organization/agencies Activities goes beyond health teachings ▪ for school community health and health information campaigns work. 6. Trai Traini ning ng func functition on 9 Duties and responsibilities of the school nurses Initiates the formulation of staff 1. Heal Healthth advo advoca cacy cy development and training programs for 2. Health Health and nutrinutritio tion n assessme assessment nt includ including ing other other midwives and other auxiliary workers screening procedures such as vision and 7. Rese Resear arch ch func functi tion on hearing. Participates in the conduct of research 3. Superv Supervisiision on of the the healt health h and safe safetyty of the and utilizes research findings in her school plant. practice 4. Treatm Treatmentent of comm common on ailmen ailmentsts and atten attendin dingg to Disease surveillance emergency cases. ▪ Measure the magnitude of the 5. Referrals Referrals and follow-up follow-up of pupils pupils and personnel personnel problem 6. Home vi visits ▪ Measure the effect of the control 7. Comm Commun unit ity y outre outreac achh program E.g.,: Competencies and skills ▪ attending community assemblies 1. Commun Community ity health health nursin nursingg proc process ess ▪ and organizing school 2. Nursing Nursing proced procedures ures during during clinic clinic and home visits community health councils. 3. Comm Commun unitity y orga organinizi zing ng 8. Record Recordinging and repo reporti rting ng of accompl accomplishishmen mentsts 4. Health Health promot promotionion and educa educatio tion n 9. Monito Monitorin ring g and eval evaluat uation ion of prog program rams s and Encourage the importance of projects. immunization for prevention Skills and competencies 13. Establishm Establishmentent of Data Bank on School Health Health 1. Assessm Assessment ent and screen screeninging skills skills and Nutrition Activities 2. Heal Health th cou counse nsell llin ing g skil skills ls Treatment in the school clinic 3. Soci Social al mobi mobili liza zati tion on skil skills ls Record of the school visit 4. Good Good oral oral and writt written en commun communica icatio tion n skills skills Health assessment report of the school 5. Basi Basic c man managagem emen entt skil skills ls health personnel 6. Life skills Health and nutritional status of 16 function of the school nurse pupils/students 1. School health and nutritional survey (from 1 st Form 86 of teaching and non teaching visit and Qyr)- for data and planning purposes personnel Survey of the ff: Teachers health profile current health situation Records of attended emergency case and nutritional status Inventory of clinic and equipment Facilities supplies Health education activities Health and nutrition activities in school 2. Puttin Puttingg up a school school clinic clinic (R.A (R.A.. 124) 124) Record of accomplishment of school 3. Health Health asses assessme sment nt (ever (everyy year year or or with with health services epidemics) Records of officers/ officials of the Purpose: School-Community Health Council and detect the signs of illness and physical their accomplishment defects for early correction. Action plan Health habits 14. School School plant inspection inspection for healthy environment environment 4. Standa Standardrd vision vision testi testing ng for schoo schooll childre children n Others concerns: school site, area, (20/20) location, space and sanitation, a classroom and others rooms, school Purpose: clinics, water supplies, sanitation, school Screen students with poor visual acuity canteen. and indentify other ocular problems Inspect for the size, lighting, ventilation, Refer students with eye disease and arrangement of seats. errors of refraction for further 15. Rapid Classroom Classroom Inspection( Inspection( after holidays and examination and management. epidemics but not to exceed more than a month 5. Ear Ear exam examininat atio ion n except for cases of epidemics) Methods: Procedure same as HA Observation Purpose: Examination by using penlight or Detect cases of CD otoscope Note the correction that have been made Screening test (whisper test, Note if the eyeglasses are correctly adjusted conversation voice test, ball pen click.) Note the general cleanliness of the students 6. Height Height and and weight weight measure measuremenmentt and nutriti nutritiona onall Note new ailments. status determination 16. Home visitation Height and weight measurement is a procedure Indication: for evaluating the tallness or the shortness and Pupils whose parents are afraid of some the heaviness of a pupil. medical procedures DepEd Pupils who get re-infected because of <10 years old=weight for age and height home conditions for age Pupils suffering from CD >10 years old= BMI Pupils who are absent frequently Appropriate school feeding programs with rice, because of sickness milk or fortified noodles are given to children Pupils who are malnourished. with below normal nutritional status for 120 •Occupational health nursing feeding days By American Association of Occupational Health Deworming is a pre requite prior to feeding • The special practice that provides for and Consent from parent is pre requisite prior to de- delivers health care services to workers and worming worker populations. 7. Medi Medicacall ref refer erra rals ls The practice focuses on promotion, protection, 8. Attend Attendanc ance e to to emerge emergency ncy cases cases and restoration of workers’ health within the 9. Student health counselling( for student who context of a safe and health work environment. manifest the physical and emotional symptoms) symptoms) Occupational health nursing is autonomous, and (parents, teacher, and student) occupational health nurses make independent 10. Health Health and nutrition nutrition education education activities activities nursing judgments in providing occupational Training programs, health services. conferences/workshops for teachers, The foundation of occupational occupati onal health nursing pupils and parents practice is research-based with an emphasis on 11. Organization of school-Community school-Community Health and optimizing health, preventing illness and injury, Nutrition Councils and reducing health hazards. Membership shall come from both school By PNA – ANSAP, 1982 and community This attend to the health related •Is aimed at assisting workers in all occupations problems and concerns to cope with actual and potential stresses in 12. Communicab Communicable le disease control control relation to their work and work environment. In participation of both the teachers, It is primarily geared at helping workers attain parents and students and maintain optimum level of physical and psychological functioning. mission ▪ disease trends including To ensure so far as possible every working man morbidity and mortality in the country is safe and in healthful working statistics, conditions ▪ and social environmental Occupational Health Team conditions 1. Occu Occupa pati tion onalal Heal Health th Nurs Nurseses ▪ that will provide 2. Occupa Occupatio tional nal phys physici icians ans-- focus focus on the pertinent information for prevention, detection, and treatment of work- the establishment of related diseases and injuries. priorities in planning and 3. Industrial Industrial hygienists- hygienists-recog recognize, nize, evaluate, evaluate, and implementing control toxic exposures and hazards in the work occupational health environment. programs 4. Safety Hazards engineers- focus on the B. Work Workerer Asses Assessmsmenent: t: prevention of occupational injuries and the maintenance Assessment of the workforce to or creation of safe workplaces and safe work practices. determine populations at risk for 5. epidemiologists- study and describe the natural occupationally related injury or illness. history of occupational diseases and injuries in Types of Classification: population groups. Age, sex, race, type of work, the 6. toxicologists- study and describe the toxic presence or absence of disability. properties of agents used in work application to which C. Applic Applicatio ationn of of Epi Epidem demiol iolog ogy y workers may be exposed. To determine relationship of work and 7. Indust Industria riall engine engineers ers-- desig designn the tool tools, s, injury or illness equipment, and machines used in manufacturing Methods use: and other work applications Toxicology, pathology, ergonomics 8. Ergono Ergonomis mists- ts- study study desi design, gn, and and promot promote e the D. Team Team Appr Approaoach ch healthy interface of humans, their tools, and Collaboration with occupational health their work. team for the development of 9. Enviro Environme nmentantall enginee engineers-rs- conce concentr ntrate ate on comprehensive occupational health environmental controls to limit environmental program pollution and achieve a healthy environment. Industrial hygienist, epidemiologist, Function of Public Health Nurse as an Occupational medical technologist, toxicologist, safety Health Nurse engineer, ergonomist, physician, 1. Work Work with with the occu occupat pation ionalal healt healthh team team occupational health nurse, occupational to lead the sanitary hygiene of all industrial health therapist establishment including hospitals to E. Progra Programm Planni Planningng and and Implem Implement entati ation on determine their Goal: promotion of wellness and prevention of compliance with the sanitation code and its illness and injury among workers. implementing rules and regulations Application: 2. Recommends to Local Health Authority the issuance Primary prevention of license/ business permits and suspensions or A program to ensure the health of revocation of the same for any violations of the prospective employees/ workers includes conditions upon which said licenses or permits had been a history and physical examination to issued, pursuant to existing rules and regulation. assess level of wellness. Maintenance of 3. Coordinates with other governments agencies relative that level is provided through to the implementation of the implementing rules and appropriate job placement. regulations Secondary Prevention 4. Attends to complaints of all establishment in the area Applied once the health problems is not of assignment related to industrial hygiene and meet by primary prevention recommends appropriate measures for immediate methods: compliance. Early detection and treatment of both 5. Participate to provide, install and maintain in good work-and non-work related health condition all control facilities and protective barriers for problems potential and actual hazards. Tertiary prevention: 6. Informs all affected workers regarding the nature Rehabilitation toward workers disabled hazards and the reasons for the control measures and by occupational and non occupational protective equiptment. problems 7. Makes a periodic testing for physical examination of Methods: the workers and other health examination related to workers exposure to potential or actual hazards in the Evaluation of current status work place Enhancement of employability, 8. Provide control measures to reduce noise, dust, and appropriate job placement of health and other hazards. employees 9. Ensure strict compliance on the regular use and Services: proper maintenance of Personal Protective Equipment Physical occupational and speech (PPE) therapy 10. Provide employees employees an occupational occupational health services Vocational training and facilities Chronic pain clinics 11. Refers or elevate to higher authority all unresolved Remedial reading issues in relation to occupational and environmental; Mathematics program health problems F. Referr Referral al to to Com Commun munity ity Resour Resources ces 12. Prepare and submit yearly reports to the local and G. Prog Progra ram m Eva Evalu luat atio ion n national Government Assessment of program to determine Application of Public Health Principles to Occupational benefits in terms of decreasing loss of Health Nursing productivity related to employee health A. Community Assessment Assess ment : problems is carried out. Identify the demographic data on Issues In Occupational Health Nursing A. A. Phys Physic ical al Haz Hazarard d Are agents within the work environment autonomy, poorly defines expectations and work that may cause tissue damage or other instructions, and absent or limited reward. physical harm. Acute: increased HR, increased BP, sleep Radiation, extreme temperature, noise, disturbances, fatigue, depression, electric and magnetic field, lasers, substance abuse, worksite violence. microwaves, and vibration. Chronic: HPN, alcoholism, CAD, mental Acute: acoustic trauma from excessive noise, illness, GI heat stress or stroke, skin rashes, eye injuries f.Occupational injury - is any injury, such as cut, fracture, from infrared radiation, skin burns, cuts or sprain, or amputation that results from a single incident contusions. in the work environment. Chronic: NIHL, multiple myeloma and g.Occupational illness- illness- is any abnormal condition or leukaemia's from exposure to ionizing radiation, disorder, other than one resulting from a occupational teratogenic or genetics effects induced by injury, caused by exposure to environmental factors certain types of radiation. associated with employment. B. Chem Chemic ical al Haza Hazard rds: s: School Nursing Various forms of either synthetic or naturally Health assessment occurring chemicals in the work environment METHODS USED: may be potentially toxic or irritating to the body a. Interview system through inhalation, skin absorption, b. Nutrit Nutrition ional al Assessm Assessment ent – height height andand weight weight ingestion, or accidental injection. measurements Mists, vapors, aerosols, gases, medications, c. Vision Vision Acuity Acuity Test/ Test/ Hearin Hearing g Test Test particulate matters (dusts and fumes), solvents, d. IPPA metals, oil synthetic textiles, pesticides, e. V/S explosives, and pharmaceuticals. Specifically, f. Apprai Appraisal sal ofof the Gene Generalral and and Phys Physica icall and Ment Mental al health care workers are exposed to chemical Condition hazards such as anaesthetic gases, g. Recording chemotherapeutic and antineoplastic agents, PREPARATION: tissue fixative reagents, disinfectant and a. Well, Well, lighte lighted, d, venti ventilat lated, ed, scree screened ned room room or a detergents, sterilizing agents, solvents, latex corner of the classroom and mercury. b. 2 or 3 chair chairs s accor accordin dingg to need need Acute: respiratory irritation due to smoke, c. Waste ba basket poisoning from accidental ingestion, metal-fume d. Hand Hand was washi hing ng faci facili liti ties es fever, chemical burns, contact dermatitis and e. Tong Tongueue dep. dep.,, pen penli ligh ghtt other dermatoses f. Step/ s phphygmo Chronic: cancers (mesothelioma, bronchogenic g. Form Forms/s/ rec reco ords rds and GI carcinomas); pleural diseases; PROCEDURES OF HEALTH ASSESSMENT occupational asthma; hypersensitivity 1. Nx condu conduct ct a classr classroom oom lect lecture ure to educ educate ate the the pneumonitis, birth defects and neurological pupils on what to do during the Health disorders. Assessment. 2. 3-5 chil childre dren n at a time time should should be be waiting waiting for for the the mesothelioma assessment C. Biological Hazards: 3. Wash Wash hand hand by the star startt of heal health th asses assessme sment nt Biological agents such as viruses, bacteria, 4. Assess Assess the childr children en one one by one fungi, mold, or parasites may cause infection 5. Ins pe pection: disease via direct contact with infected a. FromFrom head head to foot foot individuals/ animals, contaminated body fluids, b. SkinSkin disea isease sess or contaminated objects, surfaces c. SignSigns s of abn abnororma mall cond condititio ion n Workers in certain occupations ( health care, d. StetStet should should be use use across across the the heart heart// lung lung biological research and animal handling) have a assessment high incidence of infectious diseases. e. Findin Findingsgs shoul should d be reco recorde rded d during during the the Acute: self limiting infections such as colds and assessment influenzas, measles, skin and parasitic STEPS infections. a. ARMS, ARMS, HANDS, HANDS, AND FINGER FINGER NAILS: NAILS: Chronic: TB, chronic Hepa B, HIV and AIDS Ask the child to roll their sleeves D. Mechanical Hazards Extend their arms Mechanical agents may cause stress on the Show hands one side first, then the musculoskeletal or other body systems other Hazards include inadequate work-station and Spread their finger tool design, frequent repetition of a limited b. EYES movement, repeated awkward movements with Ask the child to pull his lower lid using hand-held tools, local vibrations. his index finger and ask him to look up Acute: neck strain and other muscular fatigue c. TEETH from forceful exertion or awkward positioning, Ask the child to open is mouth and say and visual; fatigue. “ah” to show his throat Chronic: Raynaud's syndrome from use of d. NOSE vibrating power tools, carpal tunnel syndrome Raynaud's syndrome Ask the child to place his 2nd finger on E. Psychosocial Hazards: Hazards: the tip of the nose and pull up his nose Often related to trauma to the nature of the job, and extend his head backward the job content, the organizational structure and e. EARS culture, insufficient training and education Ask the child to push back his hair regarding job requirements, and the physical behind his ear and pull the outer ear up, condition in the work place, leadership and slightly backward/ and then forward. management styles. f. NECK and CHEST Interpersonal conflict, unsafe working Examine the neck conditions, overtime, sexual harassment, racial Chest/ back should be auscultated inequality, role conflict, shift work, limited g. HAIR Ask the pupil to run his fingers through o Pay courtesy call to community leaders. his hair several times o Choose foster families based on guidelines. Ask to show the nape by the pulling the Identifying Host Family hair up. o House is strategically located in the h. FEET/LEG community. Ask the girl to pull up her dress o Should not belong to the rich segment. The boy his trousers to their knees o Respected by both formal and informal Or you can observe while they leaders. o Neighbours are not hesitant to enter the performed marching i. GENE GENERARALL APPE APPEAR ARANANCE CE house. IMPORTANT REMINDERS IN HA: o No member of the host family should be moving out in the community. 1. If the the health health perso personne nnell is of the the opposi opposite te sex, sex, performed the procedure in the presence of the 2. Entry Phase same sex. 2. The resu result lt shoul should d be disc discuss uss to to the teac teacher her Guidelines for Entry o Recognize the role of local authorities by 3. If 4. Refer Refer case cases s that that canno cannott be handle handle stat stat paying them visits to inform their presence and activities. 5. Inform Inform parent parents s if the findin findings gs o Her appearance, speech, behavior and lifestyle should be in keeping with those of COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH (COPAR) the community residents without disregard of their being role model. Importance of COPAR o Avoid raising the consciousness of the COPAR is an important tool for community development and community residents; adopt a low-key profile. people empowerment as this helps the community workers to generate community participation in development activities. Activities Activities in the Entry Phase COPAR prepares people/clients to eventually take over the o Integration - establishing rapport with the management of a development program(s) in the future. COPAR people in continuing effort to imbibe maximizes community participation and involvement; community life. community resources are mobilized for community services. Principles of COPAR living with the community seek out to converse with people where 1. People, especially the most oppressed, exploited and deprived sectors are open to change, have the capacity to they usually congregate lend a hand in household chores change, and are able to bring about change. avoid gambling and drinking 2. COPAR should be based on the interest of the o Deepening social investigation/community poorest sector of society. study verification and enrichment of data 3. COPAR should lead to a self-reliant community and collected from initial survey society. conduct baseline survey by students, Phases of the COPAR Process results relayed through community assembly 1. Pre-Entry Phase Preparation of the Institution Leader Spotting Through Sociogram. Key persons - approached by most people o Train faculty and students in COPAR. o Formulate plans for institutionalizing Opinion leader - approach by key persons Isolates - never or hardly consulted COPAR. 3. Organization-building Phase o Revise/enrich curriculum and immersion Entails the formation of more formal structure and the inclusion program. of more formal procedure of planning, implementing, and o Coordinate participants of other evaluating community-wise activities. It is at this phase where departments. Site Selection the organized leaders or groups are being given training (formal, informal, OJT) to develop their style in managing their o Initial networking with local government. own concerns/programs. o Conduct preliminary special investigation. Key Activities o Make long/short list of potential o Community Health Organization (CHO) communities. o Do ocular survey of listed communities. preparation of legal requirements guidelines in the organization of Criteria for Initial Site Selection the CHO by the core group o Must have a population of 100-200 families. election of officers o Economically depressed. o Research Team Committee o No strong resistance from the community. o Planning Committee o No serious peace and order problem. o No similar group or organization holding the o Health Committee Organization o Others same program. o Formation of by-laws by the CHO Identifying Potential Municipalities 4. Sustenance and Strengthening Phase o Make long/short list. Occurs when the community organization has already been Identifying Potential Barangay established and the community members are already actively o Do the same process as in selecting participating in community-wide undertakings. At this point, the municipality. different committee’s setup in the organization-building phase o Consult key informants and residents. is already expected to be functioning by way of planning, o Coordinate with local government and NGOs implementing and evaluating their own programs, with the for future activities. overall guidance from the community-wide organization. Choosing Final Barangay Key Activities o Conduct informal interviews with o Training of CHO for monitoring and community residents and key informants. o Determine the need of the program in the implementing of community health program. o Identification of secondary leaders. community. o Linkaging and networking. o Take note of political development. o Conduct of mobilization on health and o Develop community profiles for secondary development concerns. data. o Implementation of livelihood projects. o Develop survey tools. MATERNAL HEALTH PROGRAM ORS for both unconscious or with convulsions Tasked: IVF if not trained to do so. to reduce MMR by three quarters by 3. Post Post part partum um blee bleedi ding ng 2015 to achieve ( millennium What to do?: Development Goal) MDG Massage uterine and expel clots. Maternal Mortality Rate (2003) If bleeding persist: CAUSE ▪ Place cupped palmed on uterine Other Complications related to pregnancy occurring in fundus and feel for state of the course of labor, delivery and puerperium contraction 1. Hypertension complicating pregnancy, childbirth ▪ Massage fundus in a circular and puerperium (25%) motion 2. Postpartum hemorrhage (20.3%) ▪ Apply bimanual uterine compression if mem treatment 3. Pregnancy with abortive outcome (9%) done and postpartum bleeding 4. Hemorr Hemorrhag hage e relat related ed toto preg pregnan nancy cy still persist. Strategic thrusts for 2005-2010 ▪ Give ergometrine 0.2mg IM and 1. Launch Launch and and imple implemen mentt Basic Basic Emerge Emergency ncy and and another dose after 15’ Obstetric Care (BEMOC) strategy in coordination Do not give: with DOH Mem to woman with eclampsia, pre- Entails establishment of facilities that eclampsia or HPN provide emergency obstetric care for 4. Intest Intestina inall para parasit site e infect infection ion every 125,000 population and which are What to do? located strategically Give mebendazole 500mg tab. Single 2. Improve Improve quality quality ofof prenata prenatall and postnatal postnatal care dose anytime from 4-9mos. Of pregnancy Pregnant women should have at least if none was given in the past 6 mos. four (4) prenatal visit Do not give: 3. Reduce Reduce wom women’ en’s s exposu exposure re to health health risk risks s Mebendazole in the 1st 1-3mos. Of Institutionalization of responsible parenthood pregnancy 4. Stakeh Stakehold olders ers must must adv advocaocate te for for health health ▪ This might cause congenital problem in the baby Resource generation and allocation for 5. Malaria health services What to do? Essential Health Service Packages A. Ante Antena nata tall Regis Registr trat atio ionn Give sulfadoxin-pyrimethamine to B. Tetanus Toxoid Immunization woman from malaria endemic areas who are in 1st or 2nd pregnancy C. Micronutrient Supplementation D. Treatment Treatment of Disease Diseasess and Other Condition Conditions s 500mg-25mg tab., 3 tabs. At the E. Clea Cleann and and Safe Safe deli delive very ry beginning of 2 nd to 3rd tri semesters not F. Recomm Recommendended ed Schedu Schedule le for Post Post Partu Partum m Care Care less than one month interval. Visits E. Clea Clean n and and Saf Safe e del deliv iver ery y Presence of skilled birth attendant G. Importance of BF Purpose 1. Antenatal Registration 2. Tetanus Toxoid Immunization to ensure hygiene during labor and delivery. Dose:0.5ml Provide non-traumatic delivery Route: Intramuscularly Site: Right or Left Deltoid/Buttocks recognize complications 3. Micronutrient Supplementation Referred those complicated deliveries to 4. Treatment of Diseases and Other Conditions high level of care Types: Steps to follow during labor, childbirth and immediate 1. Diffic Difficult ultyy of breathi breathing/ ng/ obstr obstruct uction ion of airway airway postpartum 2. Unco Unconsnsci ciou ousn snes ess s Please refer accordingly 3. Post Post part partum um blee bleedi ding ng 1. Do a quick quick check check upon upon admissi admission on for for emergen emergency cy 4. Intest Intestina inall parasi parasite te infect infection ion signs: 5. malaria Unconscious/convulsion 1.Difficulty of breathing/ obstruction of airway Vaginal bleeding What to do? Severe abdominal pain Clear the airway Looks very ill Place in her best position Severe headache with visual disturbance Refer woman to hospital with EmOC Severe breathing difficulty capabilities. Fever Do not give anything PO Sever vomiting 2. Unco Unconsnsci ciou ousn snes ess s 2. Make the woman comfortable What to do? Establish rapport with the client by greeting and Keep on her back arms at the side. interviewing to make her comfortable Tilt head backwards (unless trauma is 3. Assess the woman in labor suspected) - to determine the status during labor Lift chin to open airway LMP Clear secretions from throat. Number of pregnancy Give IVF to prevent or correct s hock. Start of labor pains Monitor BP and SOB every 15’ Age/height Monitor fluid given. If DOB and puffiness Danger signs of pregnancy develops, stop the infusion. Taking the history through interview will help Monitor UO determine the client’s condition during delivery Do not give: of baby 4. Determine the stage of labor Uterine contractions What to do: Bulging vulva Check Q 5’ for perineum thinning and Leaking amniotic fluid bulging, visible descend of the had Vaginal bleeding during contraction, emergency signs, IE FHR and mood and behavior 5. Decide if the woman can safely deliver Continue recording in the partograph. By assessing the condition of the client Not to do: and not finding any indication that could Do not apply fundal pressure to help harm the delivery of the baby deliver the baby 6. Give supportive care throughout labor. Third stage: Purpose: Between birth of the baby and delivery To deliver clean, safe and free from of the placenta fatigue What to do: 1. Encour Encourage age to to take take a bath bath at the the onset onset of of labor labor Deliver the placenta 2. Encour Encourage age to to drink drink but but not not eat as as this this may Check the completeness of placenta and interfere surgery in case needed membranes 3. Encour Encourage age to to empty empty bladd bladder er and bowe bowelsls to Not to do: facilitate delivery of the baby. Remind to empty Do not squeeze or massage the abdomen the bladder every 2 hours. to deliver the placenta 4. Encourage to do breathing technique to help 8. Monito Monitorr close closely ly within within 1hr. 1hr. After After delive delivery ry and and give supportive care. energy in pushing out the vagina. Panting can 9. Continue Continue care care after 1hr. Postpartum Postpartum.. Keep Keep watch watch be done by breathing with open mouth with 2 closely for at least 2hrs. short breaths followed by long breaths. This 10. Educate Educate and counsel counsel on FP and provid provide e FP prevent pushing at the end of the 1st stage method if available and decision was made by a 7. Monitor and manage the different stage of labour woman. -watch out for any danger signs 11. Informs, Informs, teach teach and counsel counsel the woman on 1. First First stag stage: e: not not in acti active ve labo labor r important MCH messages: Cervix: 3cms Birth registration Contraction: weak Importance of BF Frequency: < 2 to 10’ Newborn Screening for babies delivered What to do? in RHU or at home within 48hrs up to 2 Check Q 1hr. for emergency signs, weeks after birth. frequency and duration of contractions Scheduled when to return for and FHT. consultation for postpartum visit Check Q 4hrs. For fever, pulse, BP and cervical dilatation. F. Recommended Schedule for Post Partum Care Record time of ROM and color of Visits amniotic fluid G. Impo Import rtan ance ce of BF Assess progress of labor BREASTFEEDING ▪ Refer STAT to hospital with Breast milk is best for babies up to 2 complete facilities for the ff years old. Exclusive breastfeeding is recommended for for condition: the first six months of life. At about about six months, give ▪ If after 8hrs, carefully selected nutritious foods as supplements. contractions are Breastfeeding provides physical and stronger and more psychological benefits for children and mothers as well frequent but not as economic benefits for families and societies. societies. progress in cervical BENEFITS : dilatation, with or For infants without membranes a. Provid Provides es a nutrit nutrition ional al comp complete lete food food for the the ruptured young infant. b. Streng Strengthe thens ns the infan infant’s t’s immu immune ne syste system, m, It is false labor if after 8hrs there is no preventing many infections. increase in contractions, membranes are c. Safely Safely rehyd rehydrate rates s and prov provide idess essenti essential al not ruptured and no progress in cervical nutrients to a sick child, especially to those dilatation. suffering from diarrheal diseases. Not to do: d. Reduce Reduces s the infant infant’s ’s exposu exposure re to infect infection ion.. IE more frequently than Q 4hrs. BREASTFEEDING/ BREASTFEEDING/ LACTATION MANAGEMENT EDUCATION First stage: active labor TRAINING 4cms cervical dilatation Breastfeeding practices has been proved to be very What to do? beneficial to both mother and baby thus the creation of Check Q30’ for emergency signs the following laws support the full implementation of Check Q4hrs. For fever, pulse, BP and this program: cervical dilatation A. Executive Order 51 Record time of ROM and color of B. Republic Act 7600 amniotic fluid C. The Rooming-In and Breastfeeding Act Record finding in partographs/patient of 1992 record. A. EO 51 THE MILK CODE – protection and promotion of Not to do: breastfeeding to ensure the safe and adequate nutrition Do not allow woman to push unless of infants through regulation of marketing of infant delivery is imminent. It will just exhaust foods and related products. (e.g. breast milk the woman substitutes, infant formulas, feeding bottles, teats etc. ) Do not give medication to speed of B. RA 7600 THE ROOMING –IN and BREASTFEEDING ACT labor. It may cause trauma to mother of 1992 and the baby =An act providing incentives to government and private Second stage: health institutions promoting and practicing rooming-in Cervix: 10 cms. or bulging thin perineum and breast-feeding. and head visible =Provision for human milk bank. =Information, education and re-education drive Approved types of water facilities =Sanction and Regulation Unapproved type of water facility BABY Access to safe and potable drinking water Provides Antibodies Water quality and monitoring surveillance Contains Lactoferin (binds with Iron) Waterworks/Water system and well construction Leukocytes Approved type of water facilities Contains Bifidus factor-promotes growth of the Level 1 (Point Source)- a protected well or a developed Lactobacillus-inhibits the growth of pathogenic spring with an outlet but without a distribution system bacilli indicated for rural areas; For the Mother serves 15-25 households; its outreach is not e. Reduce Reduces s a woman’ woman’s s risk of of excessi excessiveve blood blood loss loss more than 250 m from the farthest user after birth yields 40-140 L/ min f. Provid Provideses a natura naturall meth methodod of delayi delaying ng pregnancies. Level II ( Communal Faucet or Stand Posts) Posts ) g. Reduce Reduces s the risk risk of ovaria ovariann and breas breastt cancers cancers With a source, reservoir, piped distribution and osteoporosis. network and communal faucets For the Family and Community Located at not more than 25 m from the farthest h. Conser Conserves ves funds funds that that other otherwis wise e would would be spent spent house on breast milk substitute, supplies and fuel to Delivers 40-80 L of water per capital per day to prepare them. an average of 100 households i. Save Saves s medi medica call cost costs s to fami famililies es and and Fit for rural areas where houses are densely governments by preventing illnesses and by clustered providing immediate postpartum contraception. Level III ( Individual House Connections or Waterworks System) POSITIONS IN BF THE BABY: With a source, reservoir, piped distributor 1. Cradle Hold = head and neck are supported network and household taps 2. Football Hold Fit for densely densely populated populated urban communities Requires minimum minimum treatment or disinfection disinfection 3. Side Lying Position ENVIRONMENTAL SANITATION BEST FOR BABIES - the study of all factors in man’s REDUCE INCIDENCE OF ALLERGENS physical environment, which may exercise a deleterious ECONOMICAL effect on his health, well-being and survival. ANTIBODIES PRESENT Includes: STOOL INOFFENSIVE (GOLDEN YELLOW) 1.1 Water sanitation EMPERATURE ALWAYS IDEAL 1.2 Food sanitation FRESH MILK NEVER GOES OFF 1.3 Refuse and garbage disposal EMOTIONALLY BONDING 1.4 Excreta disposal EASY ONCE ESTABLISHED 1.5 Insect vector and rodent control DIGESTED EASILY 1.6 Housing IMMEDIATELY AVAILABLE 1.7 Air pollution NUTRITIONALLY NUTRITIONALLY OPTIMAL 1.8 Noise GASTROENTERITIS GREATLY REDUCED 1.9 Radiological Protection Environmental Health Program 1.10 Institutional sanitation Environmental Sanitation and Promotion of Safe 1.11 Stream pollution Water Supply PROPER EXCRETA AND SEWAGE DISPOSAL PROGRAM Environmental Sanitation is defined as the study of all EHS sets policies on: factors in the man’s environment, which exercise or may Approved types of toilet facilities : exercise deleterious effect on his well-being and LEVEL II – on site toilet facilities of the water carriage survival. type with water-sealed and flush type with septic -Water is a basic need for life and one factor in vault/tank disposal. man’s environment. Water is necessary for the LEVEL III – water carriage types of toilet facilities maintenance of healthy lifestyle. connected to septic tanks and/or to sewerage system to Safe Water and Sanitation is necessary for basic treatment plant. promotion of health. health. FOOD SANITATION PROGRAM -One basic need of the family is food. And if -sets policy and practical programs to prevent food is properly prepared then one may be assured and control food-borne diseases to alleviate the living healthy family. There are many food resources found in conditions of the population the communities but because of faulty preparation and HOSPITAL WASTE MANAGEMENT PROGRAM lack of knowledge regarding proper food planning, Disposal of infectious, pathological and other Malnutrition is one of the problems that we have in the wastes from hospital which combine them with the country. municipal or domestic wastes pose health hazards to the HEALTH AND SANITATION people. -Environmental Sanitation is still a health Hospitals shall dispose their hazardous wastes thru problem in the country. incinerators or disinfectants to prevent transmission of -Diarrheal diseases ranked second in the nosocomial diseases leading causes of morbidity among the general PROGRAM ON HEALTH RISK MINIMIZATION DUE TO population. ENVIRONMENTAL POLLUTION -Other sanitation related diseases : Foci: tuberculosis, intestinal parasitism, schistossomiasis, 1. Prevention of serious environmental hazards malaria, infectious hepatitis, filariasis and dengue resulting from urban growth and industrialization hemorrhagic fever 2. policies on health protection measures DOH thru’ Environmental Health Services (EHS)unit (EHS)unit is 3. researches on effects of GLOBAL WARMING to health authorized to act on all issues and concernsin (depletion of the stratosphere ozone layer which environment and health including the increases ultraviolet radiation, climate change and other verycomprehensive Sanitation Code of the Philippines conditions) (PD 856, 1978). NURSING RESPONSIBILITIES AND ACTIVITIES WATER SUPPLY SANITATION PROGRAM Health Education – IEC by conducting community EHS sets policies on: assemblies and bench conferences. The Occupational Health Nurse, School Health Nurse and other Nursing staff shall impart the need for an effective and efficient environmental sanitation in their places of work and in school. Actively participate in the training component of the service like in Food Handler’s Class, and attend training/workshops related to environmental health. Assist in the deworming activities for the school children and targeted groups. Effectively and efficiently coordinate programs/projects/activities with other government and non-government agencies. Act as an advocate or facilitator to families in the community in matters of program/projects/activities program/projects/ac tivities on environmental health in coordination with other members of Rural Health Unit (RHU) especially the Rural Sanitary Inspectors. Actively participate in environmental sanitation campaigns and projects in the community. community. Ex. Sanitary toilet campaign drive for proper garbage disposal, beautification of home garden, parks drainage and other projects. Be a role model for others in the community to emulate terms of cleanliness in the home and surrounding. There was a man who saw a scorpion floundering around in the water. He decided to save it by stretching out his finger but the scorpion stung him. The man still tried to get the scorpion out of the water but the scorpion stung him again. Another man nearby told him to stop s aving the scorpion but the man said, “It’s the nature of the scorpion to sting. It’s my nature to love, why should I give up my nature to love just because it’s the nature of the scorpion to sting?” Don’t give up loving, don’t give up your goodness even if people around you sting… THE END See u next sem.